Iliotibial Band Syndrome

Iliotibial Band Syndrome (ITBS) is a painful knee condition that occurs as a result of friction between the iliotibial band (ITB) and the lateral epicondyle of the femur (bony part on the outside of the knee).  The ITB is a sheath of thick, fibrous connective tissue which originates from the top the iliac crest (hip bone), the tensor fascia latae muscle, and the gluteus maximus muscle. It then runs down the outside of the thigh and inserts into the outer surface of the tibia (shin bone).

The purpose of the ITB is stabilization of the leg between the hip and knee.  The friction occurs at approximately 30 degrees of knee flexion (bending), which occurs during the foot contact phase of running.  The repetitive flicking of the tendon back and forth over the bone that occurs during this phase of running can aggravate the tendon and bursa resulting in pain and inflammation.

Symptoms of ITBS:

  • Ache over the outside part of the knee that is aggravated by running
  • Pain may come on after the run or at about the same distance or time of a run
  • Pain may be more painful, sharp, and localized as the condition progresses
  • Pain may be aggravated by downhill running, running with longer stride length and with prolonged sitting

Possible Causes of ITBS:

  • A naturally wide ITB
  • Downhill running
  • Running on an angled surface
  • Excessive or inappropriate training
  • Abnormal running biomechanics
  • Trigger points in the tensor fascia latae, gluteus maximus, gluteus medius, gluteus minimus, vastus lateralis muscles and the ITB itself
  • Weak quads and hamstrings
  • Weak hip abductors
  • Excessive foot pronation (flat feet)
  • Pelvis joint dysfunction
  • Leg length discrepancy
  • Increased leg muscle tension due to adverse effects from an underlying lumbar spine dysfunction

Treatment of ITBS includes:

  • Activity modification by avoiding all pain-provoking activities such as downhill running
  • Symptomatic relief using ice, analgesics, electrical stimulation, ultrasound, laser therapy and in acute or prolonged cases a corticosteroid injection may be necessary to  relieve pain
  • Soft tissue therapy aimed at restoring normal tone and flexibility of the hip and knee musculature and the ITB, which includes:
    • Trigger point dry needling / intramuscular stimulation
    • Myofascial release
    • Deep friction massage
    • Self-massage with foam roller
    • Stretching
  • Strengthening of the deep hip stabilizing muscle
  • Addressing biomechanical abnormalities at the foot, knee, hip, pelvis, and spine
  • Taping and the use of knee straps may alleviate symptoms by redistributing the forces through the ITB
  • Correct running shoes
  • Surgery may be indicated if conservative management fails

An orthopaedic physical therapist, especially one who specializes in manual therapy and sports medicine, is trained to accurately assess and treat ITBS.  Although providing pain relief and releasing the ITB are important hallmarks of treatment, it is more important to identify the underlying contributing factors to achieve long term pain relief and to prevent future reoccurrences of the condition.